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Biases and debiasing Pat Croskerry MD, PhD

Biases and debiasing Pat Croskerry MD, PhD . The Biases. Affective Cognitive Social/Cultural. Affective Bias. When the affective state of the decision maker adversely affects decision making Due to a failure in rational/logical decision making

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Biases and debiasing Pat Croskerry MD, PhD

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  1. Biases and debiasingPat Croskerry MD, PhD

  2. The Biases Affective Cognitive Social/Cultural

  3. Affective Bias When the affective state of the decision maker adversely affects decision making Due to a failure in rational/logical decision making Usually due to ‘hot emotion’ (vivid-tepid continuum) There are about 20 known affective biases Universal Predictable Correctable (affective de-biasing)

  4. The Emotional Spectrum HOT COOL

  5. Cognitive and affective debiasing

  6. Four major issues Getting people to recognize there is a problem Accepting that change must occur Choosing an appropriate debiasing strategy Teaching and sustaining debiasing strategies

  7. Many clinicians are unaware of the problem…

  8. And some people will never change…

  9. So how do we become better decision makers?

  10. REMEMBER Most of our biases live in the intuitive mode (System 1)

  11. The most important step is de-coupling from System 1

  12. Type 1 Processes RECOGNIZED Pattern Recognition Patient Presentation Pattern Processor Executive override Dysrationalia override T Calibration Diagnosis Repetition Type 2 Processes NOT RECOGNIZED

  13. Executive override Thinking about how we think Reflection Mindfulness Metacognition System 2 monitoring of System 1 System 2 modulation of System 1 Cognitive decoupling from System 1 Cognitive debiasing

  14. We need to maintain a feral vigilance to detect biases

  15. It ain’t easy Even though bias detected Very unlikely one strategy works for all Need for multiple approaches Very unlikely one shot will work Need for multiple innoculations Need for extra vigilance in critical conditions Need for lifelong maintenance

  16. Issues that impede cognitive and affective de-biasing

  17. What strategies do we have for debiasing?

  18. Cognitive Debiasing Strategies Teach the basic rationale: DPT and where errors are Review the main cognitive and affective biases Teach specific strategies for particular biases Forcing functions Encourage decision maker to get more information Encourage metacognition and reflection Slow down Think the opposite Maintain a healthy skepticism Group decision making Educating intuition Less hubris, less overconfidence

  19. High Risk Situations Cognitive overloading Fatigue Sleep deprivation/sleep debt Negative mood/affective state Alcohol/drug influence

  20. High risk situations • Is this patient handed off to me from a previous shift     Diagnosis momentum, framing                 • Was the diagnosis suggested to me by the patient, Premature closure, framing •        nurse or another MD ?  • Did I just accept the first diagnosis that came Anchoring, availability, search satisficing, to mind ? premature closure     • Did I consider other organ systems besides the                Anchoring, search satisficing, premature closure • obvious one? • Is this a patient I don’t like for some reason ?                  Affective bias • Was I interrupted/distracted excessively while All biases • evaluating this patient?             • Did I sleep poorly last night? All biases • Am I feeling fatigued right now?    All biases                       • Am I cognitively overloaded or                                All biases over-extended right now? • Am I stereotyping this patient?                                         Representative bias, affective bias, anchoring, fundamental attribution error • Have I effectively ruled out must-not-miss diagnoses?   Anchoring, overconfidence, confirmation bias

  21. The Ultimate Debiasing Strategy? What else could this be?

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